EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units

Ten years ago 8.4% of patients in French intensive care units (ICUs) were found to have severe sepsis or shock and 56% died in the hospital. As novel therapies for severe sepsis are emerging, updated epidemiological information is required. An inception cohort study conducted in 206 ICUs of randomly selected hospitals over a 2-week period in 2001, including all patients meeting criteria for clinically or microbiologically documented severe sepsis (with ≥1 organ dysfunction). Among 3738 admissions, 546 (14.6%) patients experienced severe sepsis or shock, of which 30% were ICU-acquired. The median age of patients was 65 years, and 54.1% had at least one chronic organ system dysfunction. The median (range) Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) at onset of severe sepsis were 48 (2–129) and 9 (1–24), respectively. Mortality was 35% at 30 days; at 2 months the mortality rate was 41.9%, and 11.4% of patients remained hospitalized. The median (range) hospital stay was 25 (0–112) days in survivors and 7 (0–90) days in non-survivors. Chronic liver and heart failure, acute renal failure and shock, SAPS II at onset of severe sepsis and 24-h total SOFA scores were the independent risk factors most strongly associated with death. Although the attack rate of severe sepsis in French ICUs appears to have increased over the past decade, its associated mortality has decreased, suggesting improved management of patients. Severe sepsis incurs considerable resources use, and implementation of effective management strategies and continued research efforts are needed.

[1]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[2]  D. Edbrooke,et al.  The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. , 1999, Critical care medicine.

[3]  J. Bakker,et al.  Drotrecogin alfa (activated) in the treatment of severe sepsis patients with multiple-organ dysfunction: data from the PROWESS trial , 2003, Intensive Care Medicine.

[4]  D. Mannino,et al.  The epidemiology of sepsis in the United States from 1979 through 2000. , 2003, The New England journal of medicine.

[5]  W. R. Mccabe,et al.  Gram-negative bacteremia: IV. Re-evaluation of clinical features and treatment in 612 patients , 1980 .

[6]  G. Guyatt,et al.  New strategies for clinical trials in patients with sepsis and septic shock , 2001, Critical care medicine.

[7]  J. Vincent,et al.  Has the mortality of septic shock changed with time. , 1998, Critical care medicine.

[8]  Epidemiology of sepsis syndrome in 8 academic medical centers. , 1998, JAMA.

[9]  François Gouin,et al.  Incidence, Risk Factors, and Outcome of Severe Sepsis and Septic Shock in Adults: A Multicenter Prospective Study in Intensive Care Units , 1995 .

[10]  R. Auckenthaler,et al.  Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. , 1996, American journal of respiratory and critical care medicine.

[11]  P Wright,et al.  Changing pattern of organ dysfunction in early human sepsis is related to mortality , 2000, Critical care medicine.

[12]  J. Helterbrand,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis , 2003 .

[13]  S Lemeshow,et al.  Customized probability models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group. , 1995, JAMA.

[14]  Epidemiology of sepsis syndrome in 8 academic medical centers. , 1997 .

[15]  D. Pittet,et al.  The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. , 1995, JAMA.

[16]  J. Helterbrand,et al.  Drotrecogin alfa (activated) administration across clinically important subgroups of patients with severe sepsis , 2003, Critical care medicine.

[17]  J. Vincent,et al.  Serial evaluation of the SOFA score to predict outcome in critically ill patients. , 2001, JAMA.

[18]  Corinne Alberti,et al.  Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. , 2003, American journal of respiratory and critical care medicine.

[19]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[20]  S. Wallenstein,et al.  Comparison of severity of illness indicators in an intensive care unit. , 1991, Archives of internal medicine.

[21]  S. Dzik.  Early goal-directed therapy in the treatment of severe sepsis and septic shock , 2002 .

[22]  Derek C. Angus,et al.  Epidemiology of sepsis: An update , 2001, Critical care medicine.

[23]  D. Maki,et al.  The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida , 2002, Annals of Internal Medicine.

[24]  C. Sprung,et al.  Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. , 1998, Critical care medicine.

[25]  W. R. Mccabe,et al.  Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. , 1980, The American journal of medicine.

[26]  Y. Cohen,et al.  Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h , 2001, Intensive Care Medicine.

[27]  Corinne Alberti,et al.  Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study , 2002, Intensive Care Medicine.

[28]  D. Annane,et al.  Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. , 2002, JAMA.

[29]  M. Langer,et al.  The Italian SEPSIS study: Preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock , 1995, Intensive Care Medicine.

[30]  F Doyon,et al.  Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. French Bacteremia-Sepsis Study Group. , 1996, American journal of respiratory and critical care medicine.

[31]  M. Levy,et al.  2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference , 2003, Intensive care medicine.

[32]  Duncan Young,et al.  Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland , 2003, Critical care medicine.

[33]  Janelle Klar,et al.  Customized probability models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group. , 1995, JAMA.

[34]  C J Fisher,et al.  The clinical evaluation of new drugs for sepsis. A prospective study design based on survival analysis. , 1993, JAMA.

[35]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[36]  C. Brun-Buisson,et al.  The epidemiology of the systemic inflammatory response , 2000, Intensive Care Medicine.

[37]  M. Wichmann,et al.  Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome , 2000, Intensive Care Medicine.